Medical titles are “hierarchical” and “hardly appropriate” for person-centred care

26th November 2015

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In a comment piece in the British Medical Journal, Ashley Graham Kennedy (assistant professor of philosophy and assistant professor of clinical biomedical science, Florida Atlantic University, Jupiter, USA) argues that title “doctor” is hierarchical because it suggests that a patient is lesser than and, should defer to, a physician. She adds that this is “exactly the sort of message” that should be avoided in clinical practice.

Kennedy claims that titles have “the power to shape interpersonal relationships” and that the title “doctor” indicates that the physician is “the one in charge”. “And by introducing themselves with this title, physicians implicitly reinforce the same idea. These practices do not encourage them to respect their patients,” she writes. Therefore, Kennedy suggests that instead of a doctor introducing themselves to patient by their medical title and surname (ie. Dr Smith), they should introduce themselves by their first and last names (ie. Joan Smith).

Noting that some might argue that dropping the title “doctor” would mean that patients would struggle to identify physicians in a clinical setting, she says: “Potential problems can be easily circumnavigated. For example—‘Hello, my name is Joan Smith, and I’ll be the physician on your healthcare team today.’ Badges could still be used with the care provider’s name and role.”

Another potential objection to dropping medical titles, Kennedy explains, is that the doctor-patient relationship might become misconstrued. She acknowledges that “in medicine, as in most professions, appropriate boundaries need to be drawn”, but she says such boundaries “should create a space that is respectful of an appropriate distance between the two parties” and that the title doctor does not do this because it is “hierarchical”. According to Kennedy, the title “creates the distinction that the patient is lesser than, and should defer to the physician. It is exactly the sort of message that we ought not to send in clinic.”

Kennedy does state that patients may feel uncomfortable about calling physicians by their first names “at first” but notes that patients “once had to learn that female or non-white professionals were as fit for medical practice as their white, male counterparts”. She told Cardiovascular News: “I think that while it might be more difficult for some patients to stop calling their physicians ‘doctor’, it is still time that we, as a society, drop this title as a sign of recognition that the physician-patient relationship has changed.”

Concluding her commentary, Kennedy says: “Patients’ rights and autonomy have reshaped the physician-patient relationship in recent years. Re-educating patients about the importance of practice over titles would be worth the effort to achieve truly shared decision making in healthcare,”

In another editorial in the British Medical Journal, Dave deBronkart (policy advisor on patient engagement, Nahsua, USA) disagrees with Kennedy’s view that medical titles promotes deference and are incompatible with (in her words) “patients being equal partners in their own care.” He says that, today, “awakened and empowered” e-patients (ie. those who research their conditions and treatments on the web) are “leading a culture change” and these patients are not intimidated by medical titles. He explains: “These awakened patients simply don’t participate in the pre-transformation discourse in which ‘doctor’ connotes ‘better than you’.”